Medication overuse headache: Treatment and prognosis
- Ivan Garza, MD
Ivan Garza, MD
- Assistant Professor of Neurology
- Mayo Clinic College of Medicine
- Todd J Schwedt, MD, MSCI
Todd J Schwedt, MD, MSCI
- Associate Professor
- Department of Neurology
- Mayo Clinic
Chronic daily headache is a descriptive term that encompasses several different specific headache diagnoses. Chronic daily headache types of long duration (ie, four hours or more) include chronic migraine, chronic tension-type headache, medication overuse headache, hemicrania continua, and new daily persistent headache.
Medication overuse headache (MOH) is a common problem in clinical practice that needs to be properly managed in order to increase the likelihood of successful chronic daily headache treatment.
This topic will review the treatment and prognosis of MOH. Other clinical aspects of MOH are discussed elsewhere. (See "Medication overuse headache: Etiology, clinical features, and diagnosis".)
The remaining subtypes of chronic daily headache are reviewed separately. (See "Overview of chronic daily headache".)
Withdrawal of the overused medication as soon as possible is the treatment of choice for medication overuse headache (MOH) . It is also important to educate patients about the detrimental effects of analgesic overuse. Bridge (transitional) therapy may be useful during drug withdrawal to provide symptomatic relief. For most patients, a preventive (prophylactic) medication aimed at the suspected background primary headache disorder (eg, migraine) should be initiated either during or immediately following withdrawal . Screening and intervening for comorbid psychiatric and substance use disorders is also recommended [2,3].
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- PATIENT EDUCATION
- WITHDRAWAL OF THE OVERUSED MEDICATION
- Outpatient and inpatient strategies
- Withdrawal symptoms
- BRIDGE THERAPY
- Tizanidine plus nonsteroidal anti-inflammatory drugs
- - Protocols
- - Side effects and contraindications
- PREVENTIVE THERAPY
- FOLLOW-UP AND RELAPSE PREVENTION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS